CLINICAL DECISION-MAKING, RISK AND OCCUPATIONAL-THERAPY

Little is known about the processes involved in risk taking, and compl ex decision making of the type encountered on acute medical wards in g eneral hospitals. The purpose of the present study was to examine cert ain of these processes in the context of decisions to discharge elderl y inpatients from hospital. Vignettes of hypothetical frail and disabl ed elderly in-patients were presented to student and qualified occupat ional therapists (OTs). All the vignettes represented high risk discha rges and each of the patients expressed the desire to return to their own home. The additional diagnosis of early dementia was manipulated w ithin and between vignettes. Subjects were asked to decide on the appr opriateness of discharging each patient to (a) home and (b) a resident ial or nursing home. In addition, subjects completed a short demograph ic questionnaire which also probed aspects of their knowledge about el derly people. Results indicated that qualified OTs were less likely to overrule patients' wishes by favouring discharge of patients to resid ential or nursing home, and more Likely to favour discharge to patient s' own homes than student OTs. There was no overall main effect of dem entia on subjects' decisions. In addition to clinical experience, cert ain areas of knowledge about elderly people were significantly associa ted with different approaches to risk taking in response to the vignet tes. Undergraduate syllabi may need to be modified to incorporate more information about elderly people, the prevalence of different disease s, and direct experience of clinical decision making in the context of uncertain and risky situations.